Diet industry expands right along with North America waistlines

Unregulated industry is a haven for empty promises, experts say

Dr. Ali Zentner poses for a photo with her patient Lindsey March during a visit at her office in West Vancouver, BC, March, 26, 2013. Dr. Zentner specializes in treating obesity after having lost 175 pounds herself is working with March who has lost over 150 pounds as well.

Photograph by: RICHARD LAM
, PNG

Start dieting. Lose 30 pounds.Stop dieting. Regain 40 pounds. Repeat.

That’s the pattern for serial dieter Lynn Bagley of Squamish, and countless other Canadians. She has lost and regained the same 30 or 40 pounds over the years on all kinds of diets from Weight Watchers to Sure Slim to Dukan and now Ideal Protein.

“You lose weight, feel good for a while and then you relax a bit. You go back to your old eating habits which are going to put you right back – or worse. And it does. I’ve done it a million times,” said Bagley, who’s banking that this time will be the last.

Her daughters tell her she’s fine, stop dieting, but a body mass index over 30 put her into the obese category — along with about one in four Canadians — and also got her thinking about her health.

“I wasn’t just overweight I was obese. Your body mass index, when you’re a certain height and you weigh a certain amount, it’s alarming because you’re a candidate for stroke, diabetes. That’s what I’m more concerned about.”

That was six months and 43 pound ago and she still wants to lose another 10 pounds. Still, you can hear inner conflict over the phone lines.

“But do you want to live the rest of your life not being able to eat things that are good? I don’t know,” Bagley sighed.

Canadians pay billions of dollars each year for diet programs, diet books and diet pills — all with scant evidence that they work. Programs vary and can require payment for memberships, weekly meetings, consultations, coaching or special foods.

The weight-loss sector’s been growing by about six per cent a year since the 1980s, according to U.S. market research, at the same time as obesity rates have climbed steadily in North America. It’s worth an estimated $7 billion a year in Canada, based on our smaller population and the $65 billion Americans spend each year trying to slim down.

Louise Green, who organized a conference in Vancouver this spring called Platform for Plus-Size, says this unregulated industry is a wonder of non-performance.

“What’s ironic about it is that it’s failing millions of people and on most — whether it’s joining a program or buying a product — they have disclaimers saying ‘results are not typical,’” says Green, who is also the founder of the Body Exchange fitness franchises.

“There’s no other industry in the world that makes so much money, that fails so many people and says right on it that it doesn’t work.”

Then why do people do it?

“Societal pressure, especially for women. People are under a lot of pressure to look a certain way and to be this beautiful person So when they see something like ‘Lose 20 lbs. in a month’ and they think, ‘Hell yeah! Why wouldn’t I sign up for that?’

The Canadian Medical Association Journal railed against that sort of advertising in a 2009 editorial calling for government regulation of the industry’s “fantastical claims.” It took particular aim at vitamin B injections (a feature of the Dr. Bernstein Diet and Health Clinics) and “magical” herbal supplements said to increase metabolism or suppress appetites, none of which are proven to work.

But there are no regulations on commercial diet programs unless they include supplements that fall under Health Canada’s Natural Products Act. Health Canada routinely issues warnings against weight-loss pills sold online, in groceries, pharmacies and health food stores with names such as Lipro Diet Pills, Xiyouji Qingzhi weight loss capsules and Japan Weight Loss Blue.

The federal department declined to make a spokesperson available to The Vancouver Sun, but noted in an emailed statement that its jurisdiction stretches no further than pills, weight-loss shakes, meal replacement bars and pre-packaged meals that are regulated as food.

It suggested looking to the province for regulations on diet clinics if medicine is being practised.

The province has no rules governing commercial weight-loss plans unless complaints are filed under the Consumer Protection BC. The Better Business Bureau has extensive files on complaints in Canada and the U.S., but they mainly have to do with disputed charges, not whether a program lives up to its claims.

Dr. Ali Zentner says this approach means governments are leaving a public health crisis to the “charlatans” of the weight-loss industry.

“You take a group of people who are hugely vulnerable and you play on their vulnerabilities,” says the internal medicine specialist who has focused her West Vancouver practise on obesity issues and cardiac risk since losing 175 pounds herself.

“When you try to treat a very complicated disease with a very simple approach, you’re looking at a recipe for disaster,” says Zentner. “It sets up a vicious cycle of unrealistic expectations for patients, over and over and over again.”

She says the health system should fund obesity clinics just as hospitals sponsor healthy-heart and diabetes prevention programs. That could allow people who are struggling to lose weight to be checked by a doctor — something they tend to avoid — and then follow a three-month program of healthy eating, exercises and counselling. This kind of health spending is more effective that paying for complications from too much weight such as knee replacements, diabetes and heart disease, says Zentner.

For Dr. Laird Birmingham, a professor of psychiatry at the University of British Columbia who specializes in obesity and eating disorders, would-be dieters need to know what they’re up against and be prepared for the long haul.

Humans have evolved to hang onto fat for survival since it is how the body stores energy.

“Because fat is a really important tissue in the body, the body regulates it and it doesn’t want it to get below a certain amount. For the most part, the body regulates fat so that it doesn’t decrease.”

There’s worse news for overweight people. If adipose tissue, another name for fat, stays on for years, it raises the body’s set point for maintaining it.

“So if people gain weight … and keep that on for a couple of years, their ‘adiposesat,’ the thermostat if you will, regulates up and then it will protect fat at higher level. There’s no way of regulating it down.”

An area of hope, in his opinion, is non-exercise activity thermogenesis, or NEAT, a concept originated by Dr. James Levine, a specialist in obesity when he was at the Mayo Clinic in Rochester, Minn. Levine looked at the calories burned by overweight and lean people during daily movement, not during exercise sessions. Researchers found that obese people tend to burn about 350 fewer calories each day during routine tasks like housework, walking, standing and even fidgeting.

Birmingham likens being under layers of fat to always being wrapped in a warm blanket, a situation that doesn’t promote activity.

“If you’re wearing a fur coat you would probably do fewer of those things that burn calories. It makes you warmer, you tend to stay more still than people who don’t have the fur coat on.”

Birmingham tells his patients to turn down the heat in the house, wear cooler clothing, put a fan nearby in their work space and also arrange it so that they must reach and move more often.

As for a diet plan, he says, all the good ones are very similar: three reasonably sized meals a day, each with at least two or three ounces of protein (two eggs, half a can of tuna, one chicken thigh) to keep you feeling full, and couple of snacks. “It doesn’t sound too sexy, it doesn’t sound too weird, so people tend to doubt it, but that’s the way to do it.”

Birmingham and Zentner agree that treating obesity requires more than telling patients to eat less and exercise more. Birmingham says it’s important to first find out if there is another cause. An inactive thyroid gland, for instance, is associated with weight gain, as are medications like the birth control pill, corticosteroids such as prednisone or even Gravol.

Zentner recently wrote a book on the subject called The Weight-Loss Prescription, in which she describes approaches best suited to different groups of patients: the emotional eater, the fast-food junkie, the all-or-nothing dieter among others. An emotional eater use food as a reward for good behaviour, to get through a tough day, a crutch for loneliness — or all of the above. They need to keep their “trigger foods” out of the house, she suggests, and create new rituals for treating themselves.

She suggests changes based on what patients are likely to do for the rest of their lives, not just for a few weeks or months which is what happens on extreme diet programs. That’s how she has kept off all the weight she lost.

“When people ask me how did you do it? I say, you restructure your entire life.”

That’s what 26-year-old Lindsey March of Abbotsford is trying to do. She’s been heavy all of her life and is smaller now, at 320 pounds, than she was in Grade 7.

Her highest weight was 484 pounds 15 months ago when she was first referred to Zentner.

She lost about 10 pounds per month for a year following Weight Watchers and is now following her own plan of mainly fruits, vegetables and lean meats with no processed foods in sight.

“It’s absolutely a disease. There are a lot of misconceptions,” she says now. “Others think that it’s an all-day thing, that (obese) people are eating 24 hours a day. But people starve themselves all day and then when it’s time to eat they’re hungry and they eat the wrong things.”

“A year and a half ago, I never ate breakfast or lunch, then had supper and lots of nighttime eating, chips and pop.”

“It’s not just something that you can always control. It goes back to the misconception that big people eat all the time … the majority of them just don’t.”

Ironically, now that she is losing weight, exercising and getting out of the house more, she hears more nasty comments about her weight than then she was hiding at home.

“I think I was blind to it, I didn’t want to see it. It’s more apparent now.”

Despite that, she has friends who encourage her and she keeps setting goals. Last year it was to walk the course of a 5-km fun run which she did. This year, March is registered to walk the full 10-km Sun Run.

“The stereotypes couldn’t be further from the truth,” says Zentner. “My patients are the bravest, most inspiring individuals in the world.”

Dr. Ali Zentner poses for a photo with her patient Lindsey March during a visit at her office in West Vancouver, BC, March, 26, 2013. Dr. Zentner specializes in treating obesity after having lost 175 pounds herself is working with March who has lost over 150 pounds as well.

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